Provider Demographics
NPI:1700054558
Name:CARRASCO PAIN INSTITUTE, PA
Entity Type:Organization
Organization Name:CARRASCO PAIN INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNULFO
Authorized Official - Middle Name:TARIN
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-4825
Mailing Address - Street 1:4763 HAMILTON WOLFE RD # 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3329
Mailing Address - Country:US
Mailing Address - Phone:210-614-4825
Mailing Address - Fax:210-614-4525
Practice Address - Street 1:4763 HAMILTON WOLFE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3329
Practice Address - Country:US
Practice Address - Phone:210-614-4825
Practice Address - Fax:210-614-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4217174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1598878225OtherNPI
TX089895902Medicaid
TX00H24QMedicare UPIN